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Sun Oct 9 19:29:04 BST 2005

In a message dated 10/9/2005 1:32:14 P.M. Eastern Daylight Time,  
scho26 at sbcglobal.net writes:

Had a  elderly lady PMH asthma, involved in a MVA  rollover,dx.  fracture  
pelvis..after twenty four hours she was found unresponsive she was intubated  
and sent to CT with a diagnosis of large SDH with midline shift. Unfortunately  
no CT of head was done in the ER.  Should this be protocol and is it  protocol 
in other level one hospitals, when the MVA is a  rollover???

It is now pretty clear that mechanism should not dictate ANY specific  
evaluation--well established to be very unreliable, you should deal with the  
patient as they present to you.  And you do not give the crucial bit of  info needed 
to know if head CT should have been done on admission, tho I cannot  imagine 
how it could not have been indicated with what you describe--was there  any 
history of loss of consciousness or GCS<14 on arrival?  This is the  indication 
for head CT, nothing about mechanism.
ERF

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